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Excessive Tibial Overgrowth Associated Ankle Valgus Deformity After Pediatric Open Mid-Shaft Tibial Fracture: A Case Report, Ahmed M. Thabet, Rami Khalifa, Rasheed Alnajjar, Amr Abdelgawad

Western Journal of Orthopaedics

Tibial overgrowth after pediatric tibial fractures has been reported in the literature. Multiple factors can affect the amount of overgrowth, including age and gender of patients, type of fracture (open vs closed), degree of communion, reduction techniques, and fixation method. We describe a 10-year-old boy with a 2-cm overgrowth after sustaining an isolated open tibia fracture with an intact fibula, which is more than what has been previously described in the literature for tibia fractures. This overgrowth was associated with asymmetrical growth of the distal tibial physis, asymmetrical growth between tibia and fibula, and ankle valgus deformity.

The University Of New Mexico Orthopaedics Research Journal 2021, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Gunshot Wounds To The Foot And Ankle: Review Of Cases From A Level-1 Trauma Center, Allicia O. Imada, Jory Wasserburger, Aamir N. Ahmad, Katherine Gavin

Western Journal of Orthopaedics

Background: Gunshot injuries frequently involve the foot and ankle. The standard of care for treatment of gunshot injuries to the foot and ankle is not clear. To better understand these injuries, we completed a retrospective review of foot and ankle gunshot injuries at a level-1 trauma center seen as orthopaedic consults over a 2-year period. Methods: Orthopaedic consults for foot and ankle gunshot injuries from June 1st, 2018, through May 31st, 2020, were reviewed. Patient characteristics, zone of injury, mechanism of injury, associated injuries, treatment, follow-up, and outcomes were recorded. Results: Forty-eight foot and ankle gunshot injuries were identified, encompassing …

Distal Radial Shaft Malunion And Distal Radioulnar Joint Instability 8 Years After Postoperative Plate Failure: A Case Report, Allicia O. Imada, Casey D. Mcdonald, Deana Mercer

Western Journal of Orthopaedics

Radius shaft fractures often require operative treatment after skeletal maturity to restore functional range of motion. If the radial bow is not anatomically restored, pain and instability can occur from bony impingement and disruption of the distal radioulnar joint (DRUJ). We describe a 25-year-old woman with a radius shaft malunion and DRUJ instability. Eight years prior, at the age of 17, she underwent open reduction and internal fixation for a radial shaft fracture with subsequent reinjury at 10 weeks postoperatively. The reinjury was treated nonoperatively, and the patient went on to have painful range of motion and DRUJ instability. Radiographs …

Bisphosphonate Associated Atypical Femur Fracture And Contralateral Impending Atypical Femur Fracture In A Pediatric Patient With Osteogenesis Imperfecta: A Case Report, Benjamin Albertson, Taylor Polander, Selina Silva

Western Journal of Orthopaedics

Atypical femur fractures are rare, low-energy fractures that involve a specific constellation of radiographic findings. These fractures have been well described in adult osteoporotic patients on long-term bisphosphonates; however, little to no literature exists on atypical femur fractures in pediatric patients on long-term bisphosphonates. The use of bisphosphonates as treatment of osteogenesis imperfecta is common to reduce fracture rate and improve bone mineral density. We describe a 15-year-old adolescent boy with type I osteogenesis imperfecta on long-term bisphosphonate therapy. He presented with an atypical right femur fracture and an impending left femur fracture. To the authors’ knowledge, these findings represent …

New Diagnosis Of X-Linked Agammaglobulinemia Presenting As Multi-Focal Acute Pseudomonal Osteomyelitis And Septic Arthritis In A 16-Month Old Boy: A Case Report, Walter Dehority

Western Journal of Orthopaedics

A previously healthy 16-month-old boy presented with 5 days of fever, a limp favoring his right side, and swelling and erythema of the dorsal left foot and left great toe. Contrasted magnetic resonance imaging revealed septic arthritis of the left knee, the interphalangeal joint of the left great toe, and the left subtalar and ankle joints. He had osteomyelitis of the left talus and intraosseous abscess formation in the left calcaneus. Cultures of the blood, left knee synovial fluid, and abscess fluid all showed growth of Pseudomonas aeruginosa. He was subsequently diagnosed with X-linked agammaglobulinemia with a novel mutation in …

Reconstruction Of A Chronic Quadriceps Tendon Rupture After Multiple Failed Repair Attempts: Technique And Case Report, Lauren Edge, Elizabeth Mcleod, Om Pathak, Justin Bartley

Western Journal of Orthopaedics

Rupture of the quadriceps tendon is a relatively uncommon injury that requires prompt surgical intervention to restore the function of the extension apparatus of the knee. Early, definitive surgical intervention generally produces excellent results. In the case of delayed surgery or re-rupture, the tendon is often retracted and scarred, thus complicating subsequent repairs and resulting in poor outcomes. We describe a middle-aged man who presented 4 years after his initial quadriceps rupture, following two repair attempts that failed. Upon presentation, he was unable to perform any active extension at the knee, and he ambulated with the use of a hinged …

Bilateral Peroneal Tendon Subluxation Associated With Complex Hindfoot Fractures: A Case Report, Benjamin C. Howse, Benjamin D. Packard, Rick J. Gehlert

Western Journal of Orthopaedics

A 41-year-old man presented to the emergency department after crashing his dirt bike and sustaining bilateral subtalar fracture dislocations. The left talus underwent open reduction internal fixation. At his first postoperative visit, the patient was found to have bilateral peroneal tendon subluxation (PTS). This case report discusses the cause of PTS and the challenges associated with accurate identification and diagnosis of this injury. We review the diagnostic and therapeutic challenges associated with injury, the negative impact on clinical outcomes, and the association between PTS and hindfoot trauma.

The Utility Of Continuous Passive Motion After Anterior Cruciate Ligament Reconstruction: A Systematic Review Of Comparative Studies, Taylor D'Amore, Somnath Rao, John Corvi, Robert Jack Ii, Fotios Tjoumakaris, Michael G. Ciccotti, Kevin Freedman

Department of Orthopaedic Surgery Faculty Papers

Background: The application of continuous passive motion (CPM) after anterior cruciate ligament reconstruction (ACLR) was popularized in the 1990s, but advancements in the understanding of ACLR rehabilitation have made the application of CPM controversial. Many sports medicine fellowship–trained surgeons report using CPM machines postoperatively. Purpose: To determine the efficacy of CPM use for recovery after ACLR with respect to knee range of motion (ROM), knee swelling, postoperative pain, and postoperative complications. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed (MEDLINE), EMBASE, Cochrane, Cumulative Index of Nursing, and Allied Health Literature databases were searched from inception to January …

Trends In Leadership At Orthopaedic Surgery Sports Medicine Fellowships, Nicholas C. Schiller, Andrew J. Sama, Amanda F. Spielman, Chester J. Donnally, Benjamin I. Schachner, Dhanur M. Damodar, Christopher C. Dodson, Michael G. Ciccotti

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Fellowship directors (FDs) in sports medicine influence the future of trainees in the field of orthopaedics. Understanding the characteristics these leaders share must be brought into focus. For all current sports medicine FDs, our group analyzed their demographic background, institutional training, and academic experience.

AIM: To serve as a framework for those aspiring to achieve this position in orthopaedics and also identify opportunities to improve the position.

METHODS: Fellowship programs were identified using both the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America Sports Medicine Fellowship Directories. The demographic and educational background data for …

Leveraging Advancements In Tissue Engineering For Bioprinting Dental Tissues, Devin Grace Morrison, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

3D bioprinting allows biocompatible materials and cells to be deposited in precise locations in three-dimensional space, enabling researchers to surpass the limitations of traditional 2D cell culture and to create innovative therapies. 3D bioprinting is one of the newest tools developed in the field of tissue engineering, which has traditionally utilized a paradigm revolving around scaffolds, cells, and signals. In this review, we discuss how new developments in each of these three research areas relates to bioprinting dental tissues – specifically teeth, periodontal ligament, and alveolar bone. Important considerations include how scaffold materials and geometry affect regeneration of dental tissues, …

Low Intensity Pulsed Ultrasound (Lipus) Use For The Management Of Instrumented, Infected, And Fragility Non-Unions: A Systematic Review And Meta-Analysis Of Healing Proportions, Ross Leighton, Mark Phillips, Mohit Bhandari, Robert Zura

School of Medicine Faculty Publications

Background: Non-union occurs in approximately 5 to 10% of fracture patients, with certain bones at greater risk of failing to heal. Non-unions have a significant impact on socioeconomic costs and the patients short and long-term quality of life. Low intensity pulsed ultrasound (LIPUS) is a non-invasive therapy for non-union treatment that can improve the long-term outcome. The purpose of this study is to summarize the available literature assessing LIPUS potential to improve the union rate in instrumented, infected, and fragility non-unions. Methods: A literature search was conducted in the MEDLINE, EMBASE, and CINAHL databases for all relevant literature on the …

Iatrogenic Electrocautery Damage And Cellular-Based Corrosion Of Total Joint Arthroplasty Biomaterials, Kirsten Carol Miller

Theses and Dissertations (ETD)

Introduction. The number of patients undergoing a Primary Total Knee Arthroplasty (PTKA) has been increasing steadily each year. Of those PTKA patients, 20% report long-term pain and/or some functional deficit. Cobalt-Chromium-Molybdenum (CoCrMo) alloy is one of the most used materials in Total Joint Arthroplasty (TJA) implants due the material’s high strength, high corrosion resistance, and biocompatibility. The release of metal ions and potential occurrence of metallosis in TJA has been shown to be detrimental to the longevity of the implant. The mechanisms leading to this increase in metal ion concentrations have been up for debate, with some believing it is …

Isolated Volar Dislocation Of The Distal Radioulnar Joint Treated With Successful Closed Reduction., Matthew T Glazier, Hayden B Schuette, Benjamin A Schnee, Brian Skura, Craig Goubeaux

Surgery Articles

We report the case of A 34-year-old right-hand-dominant male who presented with an isolated left volar dislocation of the distal radioulnar joint (DRUJ) without any associated fractures. The patient had sustained the injury in an altercation in the evening prior to the presentation and had woken up the next morning with left wrist pain and restricted wrist motion. Closed reduction was successful under conscious sedation and the patient was treated conservatively with splint immobilization without needing operative intervention. This report highlights a rare injury pattern - an isolated volar DRUJ dislocation - that was successfully closed reduced, despite reports that …

Development Of A Standardized Histopathology Scoring System Using Machine Learning Algorithms For Intervertebral Disc Degeneration In The Mouse Model-An Ors Spine Section Initiative., Itzel Paola Melgoza, Srish S Chenna, Steven Tessier, Yejia Zhang, Simon Y Tang, Takashi Ohnishi, Emanuel José Novais, Geoffrey J Kerr, Sarthak Mohanty, Vivian Tam, Wilson C W Chan, Chao-Ming Zhou, Ying Zhang, Victor Y Leung, Angela K Brice, Cheryle A Séguin, Danny Chan, Nam Vo, Makarand V Risbud, Chitra L Dahia

Department of Orthopaedic Surgery Faculty Papers

Mice have been increasingly used as preclinical model to elucidate mechanisms and test therapeutics for treating intervertebral disc degeneration (IDD). Several intervertebral disc (IVD) histological scoring systems have been proposed, but none exists that reliably quantitate mouse disc pathologies. Here, we report a new robust quantitative mouse IVD histopathological scoring system developed by building consensus from the spine community analyses of previous scoring systems and features noted on different mouse models of IDD. The new scoring system analyzes 14 key histopathological features from nucleus pulposus (NP), annulus fibrosus (AF), endplate (EP), and AF/NP/EP interface regions. Each feature is categorized and …

Intraoperative Hypothermia In Patients Undergoing Total Knee Arthroplasty: A Cross-Sectional Study From A Developing Country, Ronika Devi Ukrani, Aiman Arif, Anum Sadruddin Pidani, Obada Hussein Hasan, Shahryar Noordin

Medical College Documents

Background: Intraoperative hypothermia is associated with various risk factors, morbidity, and mortality in patients undergoing total knee arthroplasty (TKA), increasing the emotional and financial burden on patients. This study aimed to identify risk factors of intraoperative hypothermia in patients undergoing TKA.
Materials and methods: All adult patients (⩾18 years) who underwent TKA from January 2016 to December 2017 at a tertiary-care hospital in Pakistan were included in this retrospective, cross-sectional study. Temperature < 36 °C was defined as hypothermia.
Results: The study included 286 patients (77.6% female) with a mean age of 61.4 ± 10.4 years. The overall proportion of intraoperative hypothermia was 26.6%. Of the total …

Does More Testing In Routine Preoperative Evaluation Benefit The Orthopedic Patient? Case Control Study From A Resource-Constrained Setting, Obada Hasan, Shah Fahad, Mohammad Mustafa, Pervaiz Hashmi, Shahryar Noordin

Section of Orthopaedic Surgery

Background: Routine preoperative tests in healthy patients not only cause extra anxiety, but may delay treatment without influencing surgical plan. This has worse impact in resource-constrained settings where fee for service rather than health insurance is the usual norm. Investigators aim to determine if "routine" pre-operative tests are justified in healthy orthopedic patients.
Methods: We conducted a non-commercialized, non-funded matched case control study in tertiary care university hospital and a level-1 trauma centre for healthy patients (ASA-1&2) admitted from January 2014-December 2016 for elective orthopedic intermediate and major procedures. Cases (patient who had a change in his/her surgical plan after …

Weight Reduction Motivation In Osteoarthritis Patients Through Nurse Practitioner Driven Education And Follow-Up: A Pilot Project, Caoilfhionn Mulvey, Martha Fuller Phd

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The ultimate goal of this short-term pilot project is for

overweight or obese osteoarthritis patients to increase their knowledge on the benefits of

weight loss and physical activity. Research shows that for every kilogram of weight lost,

2.2–4.0 kilograms of weight is taken off of the joint and could reduce joint pain up to

thirty to fifty percent and improve quality of life. Following education from the provider,

patients will understand the correlation of osteoarthritis symptom management with

weight loss.

EBP Model/Frameworks: This project utilizes the Iowa Model of Evidence-Based

Practice to Promote Quality Care. This addresses …

Reporting And Analyzing Race And Ethnicity In Orthopaedic Clinical Trials: A Systematic Review., Ryan W. Paul, Donghoon Lee, Joseph Brutico, Fotios P. Tjoumakaris, Michael G. Ciccotti, Kevin B, Freedman

Rothman Institute Papers

BACKGROUND: The distinction between race and ethnicity should be carefully understood and described for demographic data collection. Racial healthcare differences have been observed across many orthopaedic subspecialties. However, the frequency of reporting and analyzing race and ethnicity in orthopaedic clinical trials has not been determined. Therefore, the primary purpose of this systematic review was to determine how frequently race and ethnicity are reported and analyzed in orthopaedic clinical trials.

METHODS: The top 10 journals by impact factor in the field of orthopaedics were manually screened from 2015 to 2019. All randomized controlled trials related to orthopaedics and assessing clinical outcomes …

Radiologic Measurements In The Assessment Of Patellar Instability: A Systematic Review And Meta-Analysis., Alex E White, Peters T Otlans, Dylan P. Horan, Daniel Calem, William Emper, Kevin Freedman, Fotios Tjoumakaris, Md

Rothman Institute Papers

Background: Numerous diagnostic imaging measurements related to patellar instability have been evaluated in the literature; however, little has been done to compare these findings across multiple studies.

Purpose: To review the different imaging measurements used to evaluate patellar instability and to assess the prevalence of each measure and its utility in predicting instability. We focused on reliability across imaging modalities and between patients with and without patellar instability.

Study Design: Systematic review; Level of evidence, 4.

Methods: We performed a systematic review of the literature using the PubMed, SCOPUS, and Cochrane databases. Each database was searched for variations of the …

Reducing Unnecessary Crossmatching For Hip Fracture Patients By Accounting For Preoperative Hemoglobin Concentration, Raj M Amin, Varun Puvanesarajah, Yash P Chaudhry, Matthew J Best, Sandesh S Rao, Steven M Frank, Erik A Hasenboehler

Orthopedic Surgery Resident Research

BACKGROUND: Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources. Most protocols recommend type and cross of 2 red blood cell (RBC) units for patients undergoing surgery for treatment of hip fracture. Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion, but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.

AIM: To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion (C:T) ratio in hip fracture …

When Total Joint Arthroplasty After Septic Arthritis Can Be Safely Performed, Timothy L. Tan, Chi Xu, Feng-Chih Kuo, Elie Ghanem, Jaiben George, Noam Shohat, Ji-Ying Chen, Mel S Lee, Carlos Higuera, Javad Parvizi

Rothman Institute Papers

Background: Patients undergoing total joint arthroplasty (TJA) following septic arthritis are at higher risk for developing periprosthetic joint infection (PJI). Minimal literature is available to guide surgeons on the optimal timing of TJA after completing treatment for prior native joint septic arthritis. This multicenter study aimed to determine the optimal timing of TJA after prior septic arthritis and to examine the role of preoperative serology in predicting patients at risk for developing PJI.

Methods: A total of 207 TJAs were performed after prior septic arthritis from 2000 to 2017 at 5 institutions. Laboratory values, prior treatment, time from the initial …

The Effect Of Covid-19 On Pediatric Orthopaedic Trauma Volume At A Level 1 Pediatric Trauma Center In The Midwestern United States, Kirsten Norrell

Research Days

Background: School and playground closures and the cancellation of extracurricular activities in the Kansas City region on March 17, 2020 due to the COVID-19 pandemic created an unprecedented situation for children and parents. Early reports in the literature on adult and pediatric trauma volume suggested a decrease in orthopaedic injuries during the pandemic. This is the first study to report how the pandemic affected orthopaedic trauma volume at a Level 1 pediatric trauma center during the entire five months since school and activity closures went into effect.

Objectives/Goal: The aim of this study was to compare the volume and type …

Flexor Tenosynovitis After Bite By Sugar Glider, Dominick Siconolfi, James Espinosa, Alan Lucerna, Russell Mordecai

Rowan-Virtua Research Day

Flexor tenosynovitis is one of the few orthopedic emergencies, often first identified in the emergency department. Pyogenic flexor tenosynovitis is an infection of the flexor tendon sheath of a finger causing local inflammation and tissue destruction. The pathognomonic symptoms of flexor tenosynovitis are known as Kanavel’s signs, a constellation of symptoms that include: pain with passive extension of the finger, tenderness over the flexor tendon sheath, fusiform swelling of the affected finger, and the finger held in passive flexion. The most common cause of flexor tenosynovitis is penetrating trauma into the flexion tendon sheath. Our case involves a 59-year-old male …

The Contribution Of Age-Related Changes In The Gut-Brain Axis To Neurological Disorders, M Kareem Shaath, Stephen J Warner, James F Kellam, Timothy S Achor

Faculty, Staff and Student Publications

INTRODUCTION: In 2018, orthopaedic trauma had the lowest match rate among orthopaedic subspecialties. The purpose of this study was to determine the importance of factors evaluated by orthopaedic trauma fellowship directors when ranking applicants after the interview.

METHODS: An electronic survey was submitted to fellowship directors and consisted of 16 factors included in a fellowship application. Respondents were asked to rate the importance of these factors for applicants they interviewed on a 1 to 5 Likert scale, with 1 being not at all important and 5 being critical.

RESULTS: Thirty-seven fellowship directors responded (63.8%). The highest-rated factor was the applicant …

Effect Of Change In Usmle Step 1 Grading On Orthopaedic Surgery Applicants: A Survey Of Orthopaedic Surgery Residency Program Directors., Alex Gu, Jacob Farrar, Safa C. Fassihi, Seth Stake, Pradip Ramamurti, Chapman Wei, Lauren E Wessel, Duretti T Fufa, Raj D. Rao

Orthopaedic Surgery Faculty Publications

No abstract provided.

Risk Scores And Machine Learning To Identify Patients With Acute Periprosthetic Joints Infections That Will Likely Fail Classical Irrigation And Debridement., Marjan Wouthuyzen-Bakker, Noam Shohat, Javad Parvizi Md, Alex Soriano

Rothman Institute Papers

The most preferred treatment for acute periprosthetic joint infection (PJI) is surgical debridement, antibiotics and retention of the implant (DAIR). The reported success of DAIR varies greatly and depends on a complex interplay of several host-related factors, duration of symptoms, the microorganism(s) causing the infection, its susceptibility to antibiotics and many others. Thus, there is a great clinical need to predict failure of the "classical" DAIR procedure so that this surgical option is offered to those most likely to succeed, but also to identify those patients who may benefit from more intensified antibiotic treatment regimens or new and innovative treatment …

Short-Term Reoperation Risk After Surgical And Nonsurgical Management Of Isolated Greater Tuberosity Fractures, Akshar H. Patel, Olivia C. Lee, Michael J. O'Brien, Felix H. Savoie, William F. Sherman

School of Medicine Faculty Publications

Background: The outcomes and complication rates of patients with isolated greater tuberosity fractures are not well documented. The present study aimed to evaluate the reoperation rates, types of reoperations, and complications for patients undergoing open reduction internal fixation and those undergoing initial nonoperative treatment of isolated greater tuberosity fractures. Methods: An administrative claims database was queried from 2010 to 2018 for adult patients treated with open reduction internal fixation or initial nonoperative treatment within 6 weeks of sustaining a closed isolated greater tuberosity fracture. Reoperation rates, types of reoperations, local/surgical complications, and systemic complications for two cohorts were collected, and …

The Effect Of Chronic Alcohol Consumption On Exercise-Induced Muscle Damage In Young Men, Emma Hamilton, Grant Hilliard

Honors Theses

PURPOSE: To investigate the effects of chronic alcohol consumption on exercise-induced muscle damage of the knee extensors in young men. METHODS: Twenty-one males (age 21.9 ± 1.1 yr; weight 183.4 ± 27.6 lbs; height 174.0 ± 13.1 cm) performed 100 maximal eccentric contractions at 30°/sec of the knee extensors using their non-dominant leg. The isometric and isokinetic muscle strengths (60°/sec and 180°/sec) were measured pre-exercise and immediately, 24 h, 48 h, 72 h, 96 h, and 120 h post-exercise. Muscle soreness and plasma creatine kinase (CK) activity were measured pre-exercise and 24 h, 48 h, 72 h, 96 h, and …

Holding Traction During Ct: Simple Tricks To Maintain Reduction In The Lower Extremity, Garrhett G. Via, David A. Brueggeman, Alexander Chase, Jennifer L. Jerele, Kyle S. Mobley

Medical Student Research Symposium Abstracts and Posters

Traction is one of the pillars of orthopaedic injury management, as it can provide both temporizing and definitive treatment for anatomic malalignment associated with joint dislocations and fractures. In the realm of modern orthopaedic care, post-traction imaging provides the surgeon with information about resting fracture position and the overall effects of traction that are critical to preoperative planning. However, there are often circumstances in which an orthopaedic surgery provider is faced with the discrepancy between the proper sequence of orthopaedic care and the need for emergent, advanced imaging to evaluate other organ systems. In other words, they are often forced …